title: Implementation of a parental tobacco control intervention in pediatric practice.
abstract: OBJECTIVE
  To test whether routine pediatric outpatient practice can be transformed to assist parents in quitting smoking.
  
  
  METHODS
  Cluster RCT of 20 pediatric practices in 16 states that received either CEASE intervention or usual care. The intervention gave practices training and materials to change their care delivery systems to provide evidence-based assistance to parents who smoke. This assistance included motivational messaging; proactive referral to quitlines; and pharmacologic treatment of tobacco dependence. The primary outcome, assessed at an exit interview after an office visit,was provision of meaningful tobacco control assistance, defined as counseling beyond simple advice (discussing various strategies to quit smoking), prescription of medication, or referral to the state quitline, at that office visit.
  
  
  RESULTS
  Among 18 607 parents screened after their child’s office visit between June 2009 and March 2011, 3228 were eligible smokers and 1980 enrolled (999 in 10 intervention practices and 981 in 10 control practices). Practices’ mean rate of delivering meaningful assistance for parental cigarette smoking was 42.5% (range 34%–66%) in the intervention group and 3.5% (range 0%–8%) in the control group (P < .0001).Rates of enrollment in the quitline (10% vs 0%); provision of smoking cessation medication (12% vs 0%); and counseling for smoking cessation(24% vs 2%) were all higher in the intervention group compared with the control group (P < .0001 for each).
  
  
  CONCLUSIONS
  A system-level intervention implemented in 20 outpatient pediatric practices led to 12-fold higher rates of delivering tobacco control assistance to parents in the context of the pediatric office visit.
authors.affiliation: Center for Child and Adolescent Health Research and Policy, Massachusetts General Hospital, Boston, MA 02114, USA. jwinickoff@partners.org
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Winickoff
authors.forename: Emara
authors.initials: E
authors.lastname: Nabi-Burza
authors.forename: Yuchiao
authors.initials: Y
authors.lastname: Chang
authors.forename: Stacia
authors.initials: S
authors.lastname: Finch
authors.forename: Susan
authors.initials: S
authors.lastname: Regan
authors.forename: Richard
authors.initials: R
authors.lastname: Wasserman
authors.forename: Deborah
authors.initials: D
authors.lastname: Ossip
authors.forename: Heide
authors.initials: H
authors.lastname: Woo
authors.forename: Jonathan
authors.initials: J
authors.lastname: Klein
authors.forename: Janelle
authors.initials: J
authors.lastname: Dempsey
authors.forename: Jeremy
authors.initials: J
authors.lastname: Drehmer
authors.forename: Bethany
authors.initials: B
authors.lastname: Hipple
authors.forename: Victoria
authors.initials: V
authors.lastname: Weiley
authors.forename: Sybil
authors.initials: S
authors.lastname: Murphy
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Rigotti
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D019317:Evidence-Based Medicine; D005260:Female; D006284:Health Plan Implementation / Q000379:methods*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D062405:Motivational Interviewing; D009538:Nicotine / Q000008:administration & dosage; D010290:Parents / Q000193:education*; D012017:Referral and Consultation; D016540:Smoking Cessation / Q000379:methods*; D014028:Tobacco Smoke Pollution / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D014028:Tobacco Smoke Pollution; D009538:Nicotine